Citizen's Involvement Form

Citizen’s Involvement Form

If you are interested in getting involved, print and fill out the form below.

Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Work Phone
Email*
Position of Interest
Committee or Board Applying For:*
Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.
Untitled*
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am selected, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Name*
Date*
MM slash DD slash YYYY
Our Policy
It is the policy of The Town of Hermon to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Citizen’s Involvement Form